Healthcare Provider Details

I. General information

NPI: 1164024808
Provider Name (Legal Business Name): BRIANNA C NEAL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MEADOWVIEW CTR STE 300
KANKAKEE IL
60901-2062
US

IV. Provider business mailing address

70 MEADOWVIEW CTR STE 300
KANKAKEE IL
60901-2062
US

V. Phone/Fax

Practice location:
  • Phone: 815-802-0022
  • Fax: 815-802-0011
Mailing address:
  • Phone: 815-802-0022
  • Fax: 815-802-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.022388
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209022388
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: